Abstract
<jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>To determine whether prior progestin-releasing intrauterine device (progestin-IUD) use is associated with intrauterine adhesions (IUA).</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>Retrospective case-control study</jats:p> </jats:sec> <jats:sec> <jats:title>Subjects</jats:title> <jats:p>Women evaluated at a single academic reproductive endocrinology practice, including sequential patients with: (a) hysteroscopically confirmed intrauterine adhesions (IUA cases; n=371), (b) hysteroscopically confirmed endometrial polyps (polyp control group; n=348), or (c) a new patient visit for male-factor or unexplained infertility (infertile comparison group; n= 757).</jats:p> </jats:sec> <jats:sec> <jats:title>Exposure</jats:title> <jats:p>Self-reported prior contraceptive use, ascertained from structured intake forms completed prior to the initial visit; verified by chart review</jats:p> </jats:sec> <jats:sec> <jats:title>Main Outcome Measures</jats:title> <jats:p>Adjusted odds ratios (aOR) for IUA associated with progestin-IUD use, from logistic regression adjusting for age, calendar year, race/ethnicity, prior dilation and curettage/manual uterine aspiration, operative hysteroscopy, myomectomy, and prior live birth.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Progestin-IUD use was more frequent among IUA cases (29.9%) than polyp (3.4%) or fertility (11.1%) comparison groups. Compared to infertile comparators, any prior progestin-IUD use was independently associated with IUA (aOR 3.12; 95% CI 2.01–4.85). There was a duration-response pattern: use ≤5 years of total use was modestly associated with IUA case status (aOR 1.99; 1.09–3.64), whereas use >5 years of total use conferred more than a sevenfold increase (aOR 7.26; 3.27–16.11). The association persisted among surgically naïve women (aOR 3.98; 2.44–6.48) and was concentrated in those who were nulliparous, where use beyond five years conferred an approximately twelve-fold increase in odds (aOR 12.74; 5.25–30.92). Progestin-IUD use was inversely associated with polyp controls relative to IUA and infertile controls.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Prior progestin-IUD use, particularly beyond five years and among nulliparous women, was independently associated with IUA across two distinct comparison groups, warranting future prospective studies to evaluate reproductive outcomes after long-term use.</jats:p> </jats:sec>